Healthcare Provider Details

I. General information

NPI: 1619910031
Provider Name (Legal Business Name): JARED H SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13804 S 41ST ST
BELLEVUE NE
68123-3746
US

IV. Provider business mailing address

13804 S 41ST ST
BELLEVUE NE
68123-3746
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-5084
  • Fax: 402-280-5094
Mailing address:
  • Phone: 402-280-5084
  • Fax: 402-280-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5591
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: